ABSTRACT
Ovarian cancer is the most lethal of all gynecologic malignancies. The American Cancer Society estimated that 25 580 new cases would be diagnosed in the USA in 2004, with 16 090 deaths directly attributable to this disease.1 Metastatic spread of ovarian cancer to local pelvic structures is a common occurrence, with International Federation of Gynecology and Obstetrics (FIGO) stage IIB-IV disease representing a majority (71.7%) of all patients newly diagnosed with epithelial ovarian cancer.2 In this setting, survival determinants are multifactorial; however, the strongest clinician-driven predictors of clinical outcome are the administration of platinum-based chemotherapy and the amount of residual tumor following primary surgery.3-9 Resection of the primary tumor mass is a key component of the initial cytoreductive surgical effort. In spite of this, the tendency of advanced ovarian cancer to obliterate the normal anatomy of the pelvis may lead to an abbreviated debulking procedure or abandonment of primary surgery altogether.10,11 In some reports, as many as 47% of patients with advanced ovarian cancer may be left with suboptimal large-volume residual pelvic disease.12-14 It is therefore incumbent upon the surgeon operating on women with locally extensive ovarian cancer to be intimately familiar with the relevant pelvic anatomy and skilled in the techniques of radical pelvic cytoreduction that are addressed in the following pages.
